We review the FOAM from SMACC GOLD, Dr. David Story's "Is Chloride A Poison?" for a great primer on the Stewart method to acid-base. The Strong Ion Difference (SID) is essentially Sodium minus Chloride (Na - Cl). Normal = 38; a higher SID indicates metabolic alkalosis and a lower SID indicates a metabolic acidosis. "Normal Saline" has a whopping amount of chloride, which decreases the SID and has been associated with acidosis, renal insufficiency in critically ill patients, and, perhaps, mortality.

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.